My 18 year old daughter was anorexic for 8 months and her
university threatened to have her hospitalized. We helped her refeed by eating
meals with her; she decided to trust us that she needed to eat more even though
her own mind was telling her not to. She stabilized in weight but it took
a good two months before she started to appreciably gain; sometime in that time
she started uncontrollable binge eating.
This started off a once in a while thing, now it is every
day and unless we watch her, it is continuous. She will eat and eat until it
hurts and she cries because of the pain. She gets gas, bloating, and heartburn.
We pulled her out of college, and brought her home with us. My husband, son and
I share days so she always has someone there to stop her bingeing. She has
(bravely) taken the decision not to purge, but she is now getting genuinely
overweight and is desperate and blames us for advising her to eat more.
Every day she has long spells where she is crying, so she has started on
What are we supposed to do with this binge eating disorder
in the Maudsley method? She has got very sneaky about bingeing whenever we are
distracted, and it is quite confrontational to stop her in the middle of one. I
have been encouraging her to not skip meals even though she is still full from
the last binge, but I feel like a traitor as she puts on more and more weight.
Renee Hoste, PhD responds:
Bulimia and binge eating disorder are disorders that are
often characterized by shame and secrecy, so “sneaky” behavior is not uncommon.
It is important to remember that
this behavior is being driven by the eating disorder and that your daughter
needs your help to stop it. In
family-based treatment for bulimia, parents are asked to help their child
establish a regular pattern of meals and snacks, and to help them avoid
engaging in binge eating and any compensatory behavior. It sounds like you have already begun
to tackle the binge eating by making sure that a family member is available to
monitor your daughter. One thing
parents need to be aware of is when their child is likely to binge. If it seems that your daughter is
likely to binge whenever she is alone, then at this point it may be necessary
for someone to be with her at all times.
Although monitoring is often crucial, there may be times when a lapse in
monitoring is unavoidable, in which case you will want to make it difficult for
her to engage in binge eating behavior.
This may involve removing binge foods from the home, or locking cupboards
or the refrigerator.
In addition to helping their children avoid binge eating,
parents are also asked to assist them in eating regularly and in eating
appropriate amounts. You are
already encouraging her to not skip meals, which is great. For now, you and your husband may also
need to choose her portion sizes for her to ensure that she does not overeat
during meals or snacks. Also,
unless your son is quite a bit older than your daughter, I would encourage you
and your husband to assume the responsibility of monitoring your daughter and instead
have your son take on a more supportive role.
Finally, in addition to her psychiatrist, I would encourage you to look for a therapist who is familiar with family-based treatment for bulimia as outlined in le Grange and Lock's 2007 book Treating Bulimia in Adolescents: A Family-based Approach. Although your daughter is not purging, the treatment approach will guide your family as you work to help her stop binge eating.
Renee Hoste, PhD
Dr. Hoste is Clinical Assistant Professor and Director of Clinical Services and Research for the University of Michigan’s Comprehensive Eating Disorders Program. She serves as Clinical Advisor to Maudsley Parents. Read more about Dr. Hoste here.